How to treat pain in people struggling with addiction

Researchers are testing a non-drug pain treatment for people who are trying to overcome addiction.

They hope the approach, which combines behavioral therapy and social support, will help address the opioid painkiller epidemic in the United States.

“Pain is responsive to mood, and mood is responsive to social support.”

Just 10 weekly sessions of the approach, called ImPAT for Improving Pain during Addiction Treatment, had an effect that lasted up to a year in 55 US veterans who took part, according to the new results published in the journal Addiction.

Veterans who received this pain-focused care while also being treated for addiction found that the intensity of their pain decreased, their ability to function increased, and their alcohol use went down, compared to veterans who received a less-focused approach. However, the two groups had similar rates of drug use.

The researchers have already launched a follow-up study in a larger group of 480 non-veterans in a residential addiction treatment program. And the study’s authors note that the ImPAT approach has the potential to be easily and inexpensively adopted by addiction treatment centers and groups worldwide, through team members trained in standard psychological techniques.

Addiction treatment programs often have patients who suffer from chronic pain, but offer few options to treat them, says Mark Ilgen, the study’s lead author and a US Department of Veterans Affairs and University of Michigan psychologist specializing in addiction research.

“These results highlight the need for addiction treatment programs to offer a multifaceted approach that doesn’t only address substance use but also the other factors that might be driving substance use, including pain,” adds Ilgen. “We’ve shown that it’s possible to improve pain outcomes in people with addiction, and even have some spillover effects on their substance use.”

To make matters worse, “Past studies of psychosocial approaches for pain have often excluded people with drug or alcohol problems, addiction treatment programs do not usually have providers trained in pain care, and many pain specialists will not treat people who also have addiction. So patients are caught in the middle.”

All 129 patients in the study, most of them men in their 40s and 50s, were receiving outpatient addiction treatment in a CBT-based, non-abstinence setting. Half were randomly assigned to ImPAT sessions, the other half to support groups of peers, led by a therapist, where pain and addiction could be discussed.

Focus less on pain, more on life

ImPAT combines elements of cognitive behavioral therapy with another psychosocial approach called acceptance and commitment therapy.

While the two approaches aren’t usually used together, they are often used in pain treatment settings—but those clinics and programs don’t often accept people who also acknowledge they have addiction issues.

Ilgen and his colleagues hope their results will help bring the techniques into addiction treatment settings, where the cognitive behavioral therapy approach is often used.

The ImPAT technique seeks to use integrated approaches both to help patients focus less on their pain and more on other aspects of life. This includes techniques to help people adapt to their pain, find ways to distract themselves from their pain, and think of ways to function in the face of pain.

“We want to take the focus off pain and put it onto functioning, and finding pleasurable ways to spend time,” Ilgen says. “There’s also a strong link between depression and pain. Pain is responsive to mood, and mood is responsive to social support.”

The painkiller problem

The study in veterans was planned just before the rapid rise in, and increased awareness of, opioid painkiller addiction issues in the US. While opioid addiction was one of the issues faced by veterans in the study, most had issues with multiple substances.

The sharp rise in opioid addiction in recent years—often among people who started taking the painkillers as treatment for acute or chronic pain—has made the search for effective non-drug pain treatment options even more urgent, Ilgen notes.

“Long-term use of opioids can sometimes lead to a hypersensitivity to pain, so there may actually be a causal link between use of these medications and pain,” he notes. “We need to study psychological pain management approaches in opioid-dependent patients, including those receiving addiction therapies such as buprenorphine.”

In the meantime, he notes, people struggling with addiction who want to seek relief from pain should explore the full range of treatment options that have been shown to work in non-addicted patients, including physical therapy, exercise, and psychotherapy as well as antidepressant medications. And while existing prescription guidelines do not explicitly prohibit the use of opioid painkillers in people with pain who have substance use disorders, these guidelines recommend only using opioids sparingly and under close supervision, he says.

The Veterans Health Administration’s Health Services Research and Development Service funded the study.